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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Dec 26, 2015; 7(11): 1222-1232
Published online Dec 26, 2015. doi: 10.4252/wjsc.v7.i11.1222
High dose chemotherapy with stem cell support in the treatment of testicular cancer
Lazar Popovic, Gorana Matovina-Brko, Milica Popovic, Dragana Petrovic, Ana Cvetanovic, Jelena Vukojevic, Darjana Jovanovic
Lazar Popovic, Gorana Matovina-Brko, Milica Popovic, Jelena Vukojevic, Darjana Jovanovic, Medical School, University of Novi Sad, 21000 Novi Sad, Serbia
Lazar Popovic, Gorana Matovina-Brko, Dragana Petrovic, Jelena Vukojevic, Darjana Jovanovic, Department for Medical Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia
Milica Popovic, Department for Internal Medicine, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
Ana Cvetanovic, Department for Oncology, Clinical Center Nis, 18000 Nis, Serbia
Author contributions: Popovic L wrote core of the manuscript, collected the data; Matovina-Brko G, Petrovic D and Vukojevic J collected the data; Popovic M collected the data and tables; Cvetanovic A collected the data, finalized the manuscript writing; Jovanovic D wrote parts of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lazar Popovic, MD, PhD, Department for Medical Oncology, Oncology Institute of Vojvodina, Put Dr Goldmana 4, 21204 Sremska Kamenica, Serbia. lazar.popovic@yahoo.com
Telephone: +381-21-4805569
Received: December 31, 2014
Peer-review started: January 1, 2015
First decision: February 7, 2015
Revised: September 18, 2015
Accepted: November 13, 2015
Article in press: November 17, 2015
Published online: December 26, 2015
Abstract

Testicular germ cell cancer (TGCC) is rare form of malignant disease that occurs mostly in young man between age 15 and 40. The worldwide incidence of TGCC is 1.5 per 100000 man with the highest rates in North Europe. After discovery of cisplatin cure rates of TGCC are very favorable between 90%-95% and unlike most solid tumors, cure rate for metastatic TGCC is around 80%. Metastatic TGCC is usually treated with 3-4 cycles of bleomycin, etoposide, cisplatinum chemotherapy with or without retroperitoneal surgery and cure rates with this approach are between 41% in poor risk group and 92% in good risk group of patients. Cure rates are lower in relapsed and refractory patients and many of them will die from the disease if not cured with first line chemotherapy. High dose chemotherapy (HDCT) approach was used for the first time during the 1980s. Progress in hematology allowed the possibility to keep autologous haematopoietic stem cells alive ex-vivo at very low temperatures and use them to repopulate the bone marrow after sub-lethal dose of intesive myeloablative chemotherapy. Despite the fact that there is no positive randomized study to prove HDCT concept, cure rates in relapsed TGCC are higher after high dose therapy then in historical controls in studies with conventional treatment. Here we review clinical studies in HDCT for TGCC, possibilities of mobilising sufficient number of stem cells and future directions in the treatment of this disease.

Keywords: High dose chemotherapy, Germ-cell cancer, Stem cell transplantation, Plerixafor

Core tip: High dose chemotherapy with autologous haematopoietic stem cell transplantation is effective option in treating relapsed metastatic germ-cell cancer. We reviewed this topic in regard of clinical studies, optimal mobilising and conditioning regimens, with special review on plerixafor in this indication. We also analysed riska adapted approach in those patients and future directions in field.